| National Provider Identifier [NPI]: | 1184830358 |
| Last Name Of The Provider | BENNETT |
| First Name Of The Provider | KEISA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD, MPH |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | K307 KENTUCKY CLINIC |
| Street Address 2 Of The Provider | 740 S LIMESTONE |
| City Of The Provider | LEXINGTON |
| Zip Code Of The Provider | 405360001 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 559 |
| Number Of Medicare Beneficiaries | 176 |
| Total Submitted Charge Amount | 83526 |
| Total Medicare Allowed Amount | 39567.89 |
| Total Medicare Payment Amount | 29323.97 |
| Total Medicare Standardized Payment Amount | 31652.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 56 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 917 |
| Total Drug Medicare AllowedAmount | 508.46 |
| Total Drug Medicare PaymentAmount | 484.42 |
| Total Drug Medicare Standardized Payment Amount | 484.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 503 |
| Number Of Medicare Beneficiaries With Medical Services | 176 |
| Total Medical Submitted Charge Amount | 82609 |
| Total Medical Medicare Allowed Amount | 39059.43 |
| Total Medical Medicare Payment Amount | 28839.55 |
| Total Medical Medicare Standardized Payment Amount | 31168.37 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 82 |
| Number Of Beneficiaries Age 65 to 74 | 62 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 100 |
| Number Of Male Beneficiaries | 76 |
| Number Of Non Hispanic White Beneficiaries | 128 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 85 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 91 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 45 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.7134 |